腦部及顱骨之轉移性肝癌

Primary Hepatocellular Carcinoma with Craniocerebral Metastasis

黃卓明(J. M. Huang) ； 薛如璋(L. C. Shieu) ； 程東照(T. C. Cheng) ； 方名熹(M. S. Fong) ； 杜炎昌(Y. C. Tu)

《Journal of Medical Sciences》 4卷3期 (1982/01) Pp. 1333-1338

摘要

原發性肝癌少見腦部及顱骨之轉移，其續發性轉移症狀先顯於原發性肝病症狀，則更罕見。本文報告一例，其原發性肝病徵候並不顯著，肝功能幾近正常，而臨床上先表現出轉移的症狀，有頭部腫塊，病灶處頭痛，腦壓增高及視野對側偏盲的現象，最後經病理證實確定診斷。

並列摘要

Primary hepatocellular carcino ma is one of the most common malignancies in Taiwan. The incidence is about 5.5% of autopsy cases and 21.8% among the malignancies. Althrough the extrahepatic metastasis of hepatoma has been noted in 50%-78% of autopsy patient, it has been rarely repoted with craniocerebral metastasis even in the regions where hepatoma is commonly seen. Only one such case of 414 hepatoma was found in TSGH from June 1970 to June 1981. (0.24%) The case presented here clinically manifested with a soft progressively protruding painless mass over Lt. parieto-occipital region of head, the biopsy of the mass was reported to be metastatic carcinoma, through a series of examination, it was proved to be a case of primary hepatocellular carcinoma with craniocerebral metastasis. The low incidence of such case found clinically, may be related to No. of cases autopsied, short survival duration of the disease itself before the metastatic lesions become manifested and overlooked or covered by the symptoms of hepatic or other metabolic encephalopathy. Clinically, about 10% cases of hepatoma may have no palpable liver and normal alkaline phosphatase and alpha-fetoprotein, if progressively increase of alkaline phosphatase and alpha-fetoprotein were found during the clinical course, hepatoma should be suspected and further study is indicated. The bony metastasis of hepatoma may have osteolytic change in plain x-ray film examination, in cry ptogenic bony metastasis, it is necessary to take hepatoma into consideration in the differential diagnosis of a primary site. For symptomatic relief of the metastatic bony and skull lesions in hepatoma, local irradiation seems to be useless.